ID FC 2.txt

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gm1147
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169356
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ID FC 2.txt
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2012-09-06 20:40:53
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Step2 ID FC set2
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  1. Imaging of pyelonephrtitis
    • Indicated once fever persists for 5-7d of tx.
    • U/S or CT
    • Drain abscess and culture
  2. Endocarditis tx
    • Empiric: vanc + gent
    • Virdans: 4 weeks ceftriaxone
    • Staph: Oxacillin, nafcillin, cefazolin. If prosthetic, add rifampin
    • Fungal: Amphotericin and valve replacement
    • Staph epidermidis or MRSA: Vanc + gent
    • Enterococci: Amp+ gent
    • HACEK: ceftriaxone
    • Resistance: Add aminoglycoside
    • Surgery if CHF, rupture, prosthetic, block, fungal, abscess, AV block, emboli which on abx
  3. HACEK
    • Haemophilus aphrophilus and parainfluenza
    • Actinobacilus
    • Cardiobacterium
    • Eikenella
    • Kingella
  4. Endocarditis ppx
    • Amox
    • If pen all, clinda, azithro, or clarithro
  5. Lyme rash timing and prevalence
    5-30days after tick bite. 85-90% of pts
  6. Lyme joint involvement
    • 60% of pts
    • Oligo
    • 24000 WBC in aspirate (nondistinguishing)
    • Knee most common
  7. Neuro Lyme
    • 10-15%
    • Bell palsy
    • Meningitis, encephalitis, CN palsy
  8. Cardiac lyme
    • 5-10%
    • AV block, Myocarditis, ventricular arrythmia
  9. Lyme tx
    • Rash: doxy or amox
    • Joint or bell: doxy or amox
    • Cardiac or neuro: IV ceftriaxone
    • Tick bite IDed as ixodes scapularis, attached longer than 24hrs, engorged, or endemic area: 1 dose of doxy
  10. Risk of transmission of HIV order
    perinatal, anal, needle stick, oral receptive, vaginal receptive, vaginal insertive
  11. CD4 >200 infections
    Shingles, HSV, TB, candidasis, bacterial pna
  12. HIV test
    • ELISA
    • confirmed by Western
    • infants - PCR or viral cx
  13. Tx of HIV
    • CD4 < 500, viral >100,000, or opportunistic infection
    • -emtricitabine (NRTI), tenofovir (NRTI), and efavirenz (nonNRTI)
    • -if resistant, 3 drugs with at least 2 classes of NRTIs, nonNRTIs, protease inh
    • -Then entry inhibitors (enfuvirtide or maraviroc) or integrase inh (raltegravir)
  14. Sides of HIV meds:
    • Zidovudine
    • Stavudine and didanosine
    • Abacavir
    • protease inh
    • indinavir
    • tenofovir
    • efavirenz
    • Anemia
    • periph neuropathy, pancreatitis
    • hypersens, SJS
    • Hyperlipid, hyperglycemia
    • nephrolithiasis
    • renal insufficiency
    • teratogenic - use a protease inh instead
  15. Pregnant HIV tx
    • Efavirenz is teratogenic
    • Keep on other meds or start meds if indicated
    • If mom is fine, tx during 2nd and 3rd trimesters
    • Intrapartum +6 weeks zidovudine for baby
    • If CD4 <350 or viral >1000 - Csection
  16. Beta lactams
    • Penicillins,
    • cephalosporins,
    • carbapenema,
    • aztreonam.
  17. Bugs tx by pen
    • Strep viridans,
    • strep pyogenes,
    • oral anaerobes,
    • syphilis,
    • leptospira
  18. Bugs tx by amp and amox
    • All of pen plus
    • ecoli,
    • lyme,
    • gram neg (HELPS) Hflu, Ecoli, Listeria, Proteus, Salmonella
  19. Amp/amox is best initial tx for
    • Otitis media
    • dental
    • endocarditis ppx,
    • limited lyme,
    • pregnant uti,
    • listeria,
    • enterococcal.
  20. Oxacillin, dicloxacillin, nafcillin are used for
    • Skin (cellulitis, impetigo, erysipelas),
    • staph (endocarditis, meningitis, bacteremia),
    • sensitive osteo or septic joint.
  21. Piperacillin, ticarcillin, azlocillin, mezlocillin bug and are best initial for
    • Gram neg (Ecoli, proteus) and pseudomonas.
    • Cholecystitis, asc cholangitis,
    • pyelo,
    • bacteremia,
    • hospital acquired pna,
    • neutropenia fever.
  22. Bugs resistant to all cephalosporins
    • Listeria,
    • mrsa,
    • enterococcus
  23. Bugs tx by all cephalosporins
    • Strep a, b, c, viridans,
    • Ecoli,
    • klebsiella,
    • proteus
  24. Pen allergy alternative
    • If rash, use cephalosporin.
    • If anaphylaxis, use non beta lactam abx
  25. First gen cephalosporin
    • Cefazolin,
    • cephalexin,
    • cephradrine,
    • cefadroxyl.
    • Staph, strep, Ecoli.
  26. 2nd gen ceph
    • Cefotetan,
    • cefoxitin,
    • cefaclor,
    • cefprozil,
    • cefuroxime,
    • loracarbef.
    • 1st+ better for anaerobes and gram neg. Most good for upper resp
  27. Cefotetan or cefoxitin
    • 2nd gen ceph.
    • Best initial for pid with doxy.
    • Inc bleeding risk and disulfiram like
  28. 3rd gen ceph
    • Cedtriaxone,
    • cefotaxime,
    • ceftazidime
  29. Ceftriaxone
    • 3rd gen.
    • First line for pneumococcus.
    • Meningitis,
    • comm pna with a macrolide,
    • gonorrhea,
    • lyme in heart or brain.
    • Neonates can't metabolize it in biliary.
  30. Cefotaxime
    • 3rd gen ceph.
    • Better in neonate.
    • Good for SBP
  31. Ceftazidime
    • 3rd gen cephalasporin.
    • Pseudomonal
  32. Cefepime
    • 4th gen cephalasporin.
    • Better at staph.
    • Used for neutropenia fever, vent pna
  33. Carbapenems
    • Imipenem, meropenem, ertapenem, doripenem.
    • Resistant gram neg. Neutropenia fever.
    • All but ertapenem cover pseudomonas.

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